Addressing Tuberculosis

Since 2002, the USAID/EA Office of Regional Health and HIV/AIDS has been developing the capacity of African partners to improve and expand Tuberculosis (TB) prevention, diagnosis and treatment programs.

USAID/EA provides services to 12 client countries in the region including four “limited presence” countries (Burundi, Central African Republic, Djibouti and Somalia). Out of these, five are regarded as high burden TB countries (Democratic Republic of Congo, Ethiopia, Kenya, Uganda, and Tanzania). USAID/EA also provides technical assistance to USAID limited presence countries – Burundi, Central African Republic, Djibouti and Somalia. Treatment success rates (measured as a percentage of cases that are cured or in compliance with which a full course of treatment) in USAID-supported countries surpasses the average for Africa (estimated at 75%).

This region has both high and low HIV prevalence countries (a high prevalence country is defined as one with an adult prevalence of 4+ percent). Consistent with the policy recommendations of the Global Health Initiative, USAID/EA emphasizes evidence-based strategies “to do more of what works where it works”. Countries with high TB/HIV co-infection rates are priority countries. USAID/EA also focuses on high-risk settings such as prisons.

Challenges in the region include difficulties in delivering high quality DOTS Short Course, which has contributed to the spread of Multidrug Resistant TB (MDR-TB) in the region. As national TB programs changed drug regimens to include the recommended first-line drug (rifampicin), MDR-TB rates have been rising, forcing national health systems to employ the use of second-line drugs as well as to research the extent of the problem.

In recognition of the need to improve the quality of the treatment, Directly Observed Treatment Short Course (DOTS), USAID/EA is working with the Regional Center for Quality of Health Care (RCQHC) to strengthen the capacity of health workers to reduce pediatric TB and HIV.